CYTOLOGY OF BODY FLUID

Schematic representation of the three body cavities

Accumulation of fluids in body cavities

Transudates

Increased hydrostatic pressure: Congestive heart failure

Decreased oncotic pressure (decreased albumin) : liver cirrhosis, nephrosis, and malnutrition Exudate

Inflammation: Infection, infarction, hemorrhage

Tumor

DIFFERENCES BETWEEN TRANSUDATE AND EXUDATE

Feature
Gross appearance Specific gravity

Transudate
Watery, clear

Exudate
Turbid or cloudy

Less than 1015

Less than 3mg/dl

More than 1015

More than 3mg/dl

Protein
Clots cells

No
Usually benign: Few

Yes
More mesothelial cells, or chronic

mesothelial acute

cells, few histocytes inflammatory

and lymphocytes

cells,

RBCs, malignant cells

DIAGNOSTIC ROLE OF EFFUSION CYTOLOGY

It

is very useful for diagnosis of premalignant and

malignant tumors, especially metastatic tumors.

It

is very useful for diagnosis of inflammatory

conditions (septic effusion, or chronic specific

inflammation e.g. TB

Non-Gynecological Specimen Collection

Respiratory Urinary Oral

Tract

Tract

Cavity Tract

Gastrointestinal Effusions

(pleural, pericardial, joint)

Cerebral

Spinal Fluid
fluid

Amniotic

Many other body sites

EXAMINATION OF BODY FLUID

Gross Total

exam

cell count exam

Microscopic Any

other special test (Chemistry, Microbiology,

cytology(
Test

are performed in various areas of lab based on what

the physician orders.

Body

fluids sterile vs. non-sterile

SAMPLE COLLECTION

FNA of effusion fluids Tapping

Collection and preparation of specimen

FIXATION
1ml

of heparin + 100ml of effusion fluid to prevent

clotting
N.B.:

do not use alcohol in fixation of fluid before

spread cytological smear on glass slides

TYPES OF STAINING SMEARS

PAP Gram

Stain

Hx

&E
block for remnant sediment and histopathological

Cell

examination.
Other

special stains for the most suspected diseases, to

confirm diagnosis.

Cell block
Adding plasma and thrombin solution Wrapped in filter paper Placed in a cassette

Heparinized bottles (3 units heparin/ml) Unfixed

Cytocentrifuge preparation Alcohol-fixed Papanicolaou-stained

Air-dried cytocentrifuge preparation

Embedded in paraffin
Cut and H&E stain

(Hematologic malignancy is suspected)

1- CEREBROSPINAL FLUID
Fluid

surrounding brain and spinal cord

Sterile Specimen Collect Gross

collection: by Lumbar puncture

3-5 vials, each tube has a designated department.

exam: Turbidity, Color, microscopic exam, cell

count

CSF CELL DIFFERENTIAL

Numerate

and differentiate cells seen usually are few; increased with viral,

Lymphocytes:

fungal, bacterial meningitis, or nervous system disease

Monocytes:

Less than 2% of normal CSF, increased

with TB meningitis, viral encephalitis, subarachnoid hemorrhage.

PMN: are few, associated with Viral and acute bacterial

inflammation.

Macrophages: are few in number associated with malignancy,

hemorrhage, inflammation

Eosinophils/Basophils:

not normally seen in CSF

Plasma cells: not normally present; associated with viral disorders, and Hodgkin's diseases.

Red Blood Cells: Few to none present

Mesothelial cells: not present

Malignant cells: will see with malignant disease and infiltrate.

2- Pleural Fluid: Lung fluid

Effusion:

Transudate

Exudates

Lab analysis: Gross exam, cell count, etc.

Differential: PMN, Lymph, Mono, etc.

Cells unique to the lungs: Mesothelial cells RBCs and WBCs: are limited, if increased without

traumatic tap ----- indicates infarction

Cytology exam: useful in identifying malignancy or abnormal morphological cells.

3- PERITONEAL FLUID
Abnormal

accumulation of fluid (effusion) in peritoneal

cavity: Ascites
Ascites:

a condition in which fluid accumulates within

the peritoneal space.

Must have an accumulation of > 100ml (several 100) before effusion can be detected on physical exam.

Removal procedure-

paracentesis

Lab analysis: distinguish between transudate and exudates,

gross exam, cell count, sedimentation, chemical analysis

PHYSICAL CHARACTERISTICS
Peritoneal

Fluid Appearance: Color and clarity.

Color and clarity can indicate certain infections and diseases.

Total

Cell Count: Assist in diagnosis of certain

diseases by determining total RBC and WBC number.

 Lymphocytes: Mesothelial Malignant

CHF, liver cirrhosis, nephrotic syndrome

Cells: Associated with TB effusions

cells: seen with malignancy

4- Pericardial Fluid
Pericardial

Fluid: accumulation of fluid of the lining of

the heart (effusion)

Cause:

neoplasm, infections, collagen disease, renal

disease, Cardiovascular disease.

Gross

Exam: Report appearance (bloody, clear, cloudy)

Measure pH: pH less than 7.0 associated with infection or rheumatoid disorder.

Cell count: see limited RBCs and WBCs Evaluate sedimentation

5- Seminal Fluid

Examine physical, chemical and microscopic detail Count number of sperm, report morphology and motility

Specimen must be a fresh collection-clean, sterile container.

Gross Exam: Color, pH, Volume, and viscosity. Agglutination study

6- Synovial Fluid:

Joint Fluid: normally clear, viscous

Functions as a lubricate and transports nutrient

Arthrocentesis: aspirate of the joint fluid, aseptic technique

Lab Assay: Gross exam, microscopic exam, Gram stain, cultures,...

Appearance: clear, transparent, viscous

Viscosity test Mucin Clot test Note crystals (intracellular vs. extra cellular)

Slide exam: usually performed on concentration of the fluid using Giemsa or Papnicolaou

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